Provider Demographics
NPI:1669816013
Name:ROBERTS, SARAH BETH (LPN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 WABASH ST
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2935
Mailing Address - Country:US
Mailing Address - Phone:607-207-3275
Mailing Address - Fax:
Practice Address - Street 1:180 WABASH ST
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2935
Practice Address - Country:US
Practice Address - Phone:607-207-3275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-28
Last Update Date:2013-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306451-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse